Panic Disorder (cont.)

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

terror, a sense that something unimaginably horrible is about to occur and one is powerless to prevent it;

a need to escape;

nervousness about not knowing how to control their symptoms, leading to them doing something embarrassing;

fear of dying.

Although the duration of a panic attack can vary greatly, it typically lasts for more than 10 minutes, is one of the most distressing conditions that a person can experience, and its symptoms can closely mimic those of a heart attack. Typically, most people who have one panic attack will have others, and when someone has repeated attacks with no other apparent physical or emotional cause, or feels severe anxiety about having another attack, he or she is said to have panic disorder. A number of other emotional problems can have panic attacks as a symptom. Some of these illnesses include posttraumatic stress disorder (PTSD), schizophrenia, and intoxication or withdrawal from certain drugs of abuse.

Certain medical conditions, like thyroid abnormalities and anemia, as well as certain medications, can produce intense anxiety. Examples of such medications include stimulants like methylphenidate (Ritalin) or amphetamine salts (Adderall), diabetes medications like metformin (Glucophage) and insulin, antimalarial medications like quinine, as well as corticosteroid withdrawal, such as withdrawal from dexamethasone (Decadron). As individuals with panic disorder seem to be at higher risk of having a heart valve abnormality called mitral valve prolapse (MVP), this possibility should be investigated by a doctor since MVP may dictate the need for special precautions to be taken when the individual is being treated for any dental problem. While the development of panic attacks have been attributed to the use of food additives like aspartame, alone or in combination with food dyes, more research is needed to better understand the role such substances may have on this disorder.

Anxiety attacks that take place while sleeping, also called nocturnal panic attacks, occur less often than panic attacks during the daytime but affect about 40%-70% of those who suffer from daytime panic attacks. This symptom is also important because people who suffer from panic symptoms while sleeping tend to have more respiratory distress associated with their panic. They also tend to experience more symptoms of depression and other psychiatric disorders compared to people who do not have panic attacks at night. Nocturnal panic attacks tend to cause sufferers to wake suddenly from sleep in a state of sudden fear or dread for no apparent reason. In contrast to people with sleep apnea and other sleep disorders, sufferers of nocturnal panic can have all the other symptoms of a panic attack. The duration of nocturnal panic attacks tends to be less than 10 minutes, but it can take much longer to fully calm down for those who experience them.

While panic disorder in adolescents tends to have similar symptoms as in adults, symptoms of panic disorder in younger children are less likely to include the thought-based or so-called cognitive aspects. Specifically, teenagers are more likely to feel unreal or as if they are functioning in a dream-like state (derealization) or be frightened of going crazy or of dying.

Symptoms of panic attacks in women tend to include more avoidance of anxiety-provoking situations, more frequent recurrence, and more often result in the use of medical care compared to panic attack symptoms in men. The frequency of panic attacks may increase, decrease, or remain unchanged during pregnancy.